3 To all users of this publication: The information contained herein has been carefully compiled and is believed to be accurate at date of publication. Freedom from error, however, cannot be guaranteed. Enquiries regarding the purchase and distribution of this manual should be directed to: Publications Ontario By telephone: or By fax: TTY: Online: For further information on the Basic Life Support Patient Care Standards, please contact: ISBN (Print) ISBN (PDF) ISBN (CD-ROM) Queen s Printer for Ontario, 2006 Emergency Health Services Branch Ministry of Health and Long-Term Care 5700 Yonge Street, 6th Floor Toronto, ON M2M 4K5 Phone Fax

4 Acknowledgements This revision of the Basic Life Support Patient Care Standards is the result of the assistance of a number of groups and individuals, such as Paramedics, EMS Directors, Base Hospital staff, Base Hospital Medical Directors, College Coordinators, Field Offices, Ornge (formerly Ontario Air Ambulance Services Co.), Legal Services Branch and Regional Training Coordinators. In particular, the Ministry would like to gratefully acknowledge the following individuals for their significant contributions: Dr. Rick Verbeek on behalf the Ontario Base Hospital Group Medical Advisory Committee Ms. Lynne Urszenyi i

5 Tips on using the interactive Basic Life Support Standards Ctrl + F = Find forward and back arrows Esc. key Alt + left arrow Use this to search the enitre document for all instances of a specific word or phrase. allows you flip pages (you can also use the arrow keys on your keyboard) escape out of full screen mode. returns to previous view (i.e. return to Table of Contents)

10 Preface The BLS Patient Care Standards state the Ministry of Health and Long-Term Care expectations with respect to how paramedics will interact with their patients. The standards set out a logical ordering of the inter-related activities and practices of paramedics, activities which start with the patient s entry point to, and end with, their exit point from the ambulance system. Process standards are intended to be instructive and educative, and should facilitate service delivery. They are intended to maximally protect patients from receiving inappropriate care, and service providers from being subjected to inappropriate legal suits, disciplinary actions, etc. In creating the standards, an assessment-based approach was utilized e.g. a standard was developed for assessment and management of shortness of breath, rather than for asthma. In the field setting, providers MUST focus on the following three aspects of patient care: a) identifying serious disruptions to critical functions - airway, breathing, circulation and level of consciousness; b) applying measures to correct these disruptions as soon as feasible, and, c) determining the need for, and where required, initiating rapid transport. Attempting to make a definitive diagnosis in the field may lead to unnecessary delays in treatment and transport. Diagnosis is of secondary importance in field practice. Each standard has been designed: a) to ensure that patient care is appropriate, safe, timely and efficient; b) to allow paramedics to exercise judgement as required by the situation; c) to account for the many diverse and adverse scene conditions which may, in some instances, alter the care provided to patients suffering from the same or similar illnesses or injuries. Where a standard was not deemed feasible or practical, guidelines have been incorporated with certain standards. The guidelines are intended to direct paramedics towards desired practices for unusual and/or less commonly encountered field situations. The benefits of having standards are obvious. All paramedics can now be assessed using the same objective criteria. Preface 1

11 Definitions For purposes of this manual the following definitions apply: Paramedic Standards Guidelines Paramedic is the same as defined under the Ambulance Act and for the purposes of this standard includes Emergency Medical Attendant as defined under the Ambulance Act and Regulation 257/00 or as may be amended from time to time, unless otherwise indicated. Criteria which will define the minimum acceptable levels or range of Basic Life Support patient care performance for ALL paramedics in Ontario. General statements intended to provide information and guidance with respect to formulation of working assessments, or, directing principles of preferred practice applicable to specific clinical circumstances where a standard is not reasonable or appropriate. Purpose of Basic Life Support Patient Care Standards To state the minimum acceptable level or range of Basic Life Support patient care performance expected of paramedics in all Ontario ambulance services, while recognizing circumstances in the field which may result in or require deviation from the minimum standards. Purpose of Basic Life Support Patient Care Guidelines To direct, guide and assist paramedics performance of Basic Life Support level patient care. Objectives of Implementation of the Standards 1. To ensure that Basic Life Support level patient care is performed in a safe, efficient, appropriate and timely manner. 2. To provide a measure of protection for patients receiving service and individuals providing service. 3. To provide a rational basis for paramedics decision-making and judgements. 4. To assist less experienced paramedics or recent graduates in developing and focusing decision-making skills, and to assist more experienced paramedics in refining and perfecting these skills. 5. To provide a fair and objective basis for assessment of paramedics performance. 2 Preface

12 6. To identify training and continuing education needs of paramedics. 7. To provide direction in the development of assessment and testing programs for paramedics. 8. To provide direction in the development of audit and other quality assurance objectives for ambulance service operators, medical control authorities and others involved in quality assurance activities for ambulance services. 9. To provide assistance and direction in decision-making for Emergency Health Services Branch staff, ambulance service operators, and others involved with resource allocation. Practice and the Basic Life Support Patient Care Standards 1. A paramedic may practice at a level or levels above the standards specified in this manual if: a) They are qualified to do so, and, b) Such practice is in accordance with their ambulance service policies. 2. When issuing directives to paramedics on patient care related topics, ambulance service operators must ensure that such directives are compatible with the standards. 3. If a paramedic performs patient care activities which they have not been trained or approved to perform, or the standard of care is not met, they may be subject to investigation and/or other actions as dictated by Ministry standards, policy, legislation and the circumstances and events surrounding the incident. Review and Revision of the Basic Life Support Patient Care Standards The standards will be reviewed at regular intervals to be determined by the Ministry of Health and Long-Term Care (MOHLTC) and by means of a Ministry approved process. Revisions will be made as necessary to ensure that the standards remain current. Preface 3

23 Conditions The General Standard of Care is applicable: 1. At all times when a paramedic is providing patient care while on duty. 2. To patient care provided by a paramedic where care is general in nature (stated or implied). 3. To patient care pertaining to certain illness or injury categories/situations as specifically defined within the General Standard of Care. 4. Under all environmental conditions, with the proviso that personal safety is assured or can be secured without loss of the paramedic s life, limb(s) or vital functions. Givens 1. Patient(s). 2. A partner (exceptions - see Note to follow). 3. An operational ambulance (includes air ambulances), or in special situations such as mass casualty incidents, an emergency first response vehicle. 4. Fully operational patient care equipment as per the MOHLTC Provincial Equipment Standards for Ontario Ambulance Services. Note: If a paramedic is on-scene alone in a first response situation, the only Given may be the patient. Under these circumstances, the paramedic will be expected to perform to the best of their abilities and will attempt to meet the standards within the restrictions imposed by the situation. Section 1 General Standard of Care 1-1

24 A. Personal and Patient Safety and Protection Pre-Arrival At Scene, At Scene The Paramedic will: 1. On receipt of a call, confirm call information with dispatch. Ensure that patient location and access information is accurate. 2. Use an appropriate route and speed to respond to the scene. Adhere to approved driving and occupant restraint policies and practices. Operate the ambulance and utilize ambulance emergency warning devices in a responsible manner. Use an appropriate alternate route if the route selected is impeded due to traffic, weather, etc. 3. On arrival at scene, perform an assessment of the environment. Park the ambulance in a safe place, as close to the point of patient contact as possible. Identify obvious and potential hazards to the patient(s) and crew. Where appropriate, identify routes of entry and exit, e.g. for multiple patient incidents; for potential violence or confrontation. 4. Secure the environment if assessment indicates there is no danger to self or others. 5. If danger exists, or there is uncertainty regarding personal and/or patient safety, request assistance from allied emergency services personnel/agencies. Initiate and/or maintain communication with ambulance dispatch. 6. Use call and scene information to determine the type of equipment and supplies likely to be required to manage problem(s). Unless prohibited by adverse conditions at scene, carry all essential patient care equipment and supplies to the site of initial patient contact. 7. Determine if there is more than one patient and assess the need for additional resources and assistance. If indicated, initiate triage as per Multiple Casualty Incident (MCI) principles. 8. Use EMS rescue and extrication techniques as required. 9. Utilize personal protective equipment according to the Ambulance Service Patient Care and Transportation Standard and take appropriate safety measures where necessary. 10. Work with your partner to ensure safe, efficient and timely patient assessment and care. If there is confusion at scene and/or bystanders are interfering with or obstructing patient assessment/management, request police assistance. In the interim, attempt to control the scene while your partner conducts patient assessment or have your partner control the scene. Alternately, instruct another responsible adult to secure the scene. 11. Advise the patient to remain still when deemed necessary e.g. for patient safety, to reduce injury potential and/or to carry out appropriate patient assessments and management. 12. Protect the patient from hazards and exposure to adverse environmental conditions. 1-2 Section 1 General Standard of Care

25 13. Ensure safe disposal of sharps in an appropriate sharps container. 14. Secure, lift and carry the patient using appropriate methods and devices. 15. Wash hands after each patient contact. If multiple patients or other circumstances at scene prevent hand-washing after each patient contact, use appropriate alcohol-based hand sanitizer or, at minimum, change gloves between patient contacts and wash hands as soon as circumstances permit. General Measures 1. Ensure that other operational procedures which impact directly or indirectly on patient care, are carried out on a regular basis. Specifically: Personal cleanliness, dress, conduct, safety and work performance; Cleanliness, decontamination, safety, maintenance and routine checks of the ambulance, ambulance premises, and all patient care related equipment and supplies; Completion and submission of Ambulance Call Reports (ACRs), incident reports and other operational documents; Familiarization with and working in accordance with legislation, standards and pertinent policies and procedures, specifically those dealing with occupational health and safety and communicable diseases; Participation in training and continuing education activities; Assistance with familiarization and orientation of new or less experienced staff. 2. In cases of unusual or suspicious situations, (e.g. suspected foul play, suicides) follow, in addition to the general and specific standards, the procedures outlined in the Police Notification Standard. Section 1 General Standard of Care 1-3

26 B. Patient Communication The Paramedic will: 1. Identify and introduce themselves to the patient and/or to bystanders at scene. Advise the patient that they are there to help. If the patient refuses treatment, see Section I of the General Standard of Care. 2. Attempt to determine the patient s name, gender, age (or approximate), and weight (or approximate). 3. Treat the patient and others at scene with respect and courtesy. Exercise tact and diplomacy. 4. Explain assessments and interventions. 5. Provide verbal, and where deemed appropriate, tactile comfort and reassurance to the patient and family/friends, including the unconscious patient. Assume that the unconscious patient is capable of both hearing and understanding. C. Patient Assessment - General Principles The Paramedic will: 1. On all scene calls, regardless of dispatch priority coding, assume the existence of serious, potentially life-, limb- and/or function-threatening conditions until assessment indicates otherwise. 2. If a physician is at scene, follow specific procedures as outlined in the Physician s Orders Standard, in addition to those outlined in the General Standard of Care. D. Patient Assessment - Environmental Assessments The Paramedic will, concurrent with or following other assessments: 1. Make scene observations. 2. Seek medical information tags/jewelry, medications, and other forms of patient identification. 3. Collect and transport all patient medications and other relevant identification for review by receiving facility staff. Document reasons if relevant identification is left at scene, e.g. suspect foul play, obvious crime scene; police prevent removal. 1-4 Section 1 General Standard of Care

First Responder (FR) and Emergency Medical Responder (EMR) Progress Log Note: Those competencies that are for EMR only are denoted by boldface type. For further details on the National Occupational Competencies

DOCUMENTATION TEMPLATES All patient care reports should include the following information in the narrative: Patient Data: -Chief Complaint -Mechanism of injury/nature of illness -Associated signs and symptoms/pertinent

M12 DRUG and ALCOHOL ABUSE EMS personnel must be aware that alcohol and drug ingestion can mask the symptoms of injury or illness. In addition, many injuries and illnesses can present as suspected alcohol

PRESENTATION Oxygen (O 2 ) is a gas provided in a compressed form in a cylinder. It is also available in a liquid form. It is fed via a regulator and flow meter to the patient by means of plastic tubing

PRESENTATION Oxygen (O 2 ) is a gas provided in compressed form in a cylinder. It is also available in liquid form, in a system adapted for ambulance use. It is fed via a regulator and flow meter to the

FIRST AID TEST AUGUST 2001 2 ND EDITION Instructions 1. Questions 1 to 25 are for Emergency First Aid. 2. Questions 1 to 50 are for Standard First Aid. 3. Choose just 1 answer from the alternatives offered,

STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH June 7, 2010 The Following Will Be Policy For Emergency Medical Service Care Providers: GUIDELINES FOR EMR, EMT, AEMT, and Paramedic DETERMINATION OF DEATH/DISCONTINUATION

It is recommended that the reader review each medical directive presented in this presentation along with the actual PCP Core medical directive. This presentation will highlight the changes and any new

Firefighter Pre-Hospital Care Program Module 18 Chest Assessment And Injuries Firefighter Pre-Hospital Care Program Module 18 At the end of the lesson and upon completion of the post test quiz, the participant

Page 1 of 21 GENERAL PATIENT UNIT When assigned to the General Patient unit paramedic student should gain knowledge and experience in the following: 1. Appropriate communication with patients and members

FAQ Important Disclaimer: The following FAQ section includes information regarding health provider decisions, health and payment matters not financial matters. None of the following questions or answers

IRECA BLS Competition 2011 Scenario 2 Is it ever safe enough? Team Name Captain Name Judge 1 Judge 2 The Event: You are dispatched to a shooting for two injured at a local bar. Witnesses have told police

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual

PURPOSE: The purpose of this policy is to establish approved Medical Priority Dispatch System response and mode assignments for use by authorized Emergency Medical Dispatch Centers. AUTHORITY: Health and

Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision

81 First Responder Medical Scenarios Asthma Scenario: You are called to a local house for a woman with trouble breathing. You arrive to find a 67-year-old woman sitting upright in a chair. She states she

IX.041 MEDICAL AND HEALTH EMERGENCIES POLICY The Board shall provide medically appropriate, immediate, quality emergency care in the event of an accident or illness that may compromise the well-being of

Waubonsee Community College Safety Day 2014 Why do we need a First Aid Program? 4,383 workers were killed on the job in 2012 Total recordable non fatal cases: 2,976,400 in 2012 Cases involving days away

SECONDARY ASSESSMENT (Detailed Exam) *Credit should be given to candidates that use a brief exam f life-threatening injuries in the Primary Survey so long as it does not delay appropriate care. Head Neck

Intravenous Cannulation and Infusion Protocol revised October 2008 Preamble Intravenous cannulation and infusion has two major roles in the EMS workplace: 1. administration of fluids as primary therapy

CHAPTER 7 EMERGENCY FIRST AID FOR FIELD ACTIVITIES 1. Introduction Every person who engages in field activities should be able to recognize injuries and exposures that require immediate emergency action.

Date: July 18, 2014 Page 1 of 5 Obstetrical Emergencies Purpose: To provide the process for the assessment and management of the patient with an obstetrical related emergency. Pre-Medical Control 1. Follow

CPR/AED for Professional Rescuers and Health Care Providers HANDBOOK TABLE OF CONTENTS SECTION 1: THE PROFESSIONAL RESCUER The Duty to Respond 2 Preventing the Spread of Bloodborne Pathogens 3 Taking Action

109-2-5. Ambulance service operational standards. (a) Each ground ambulance service in a county which has been assigned to the emergency medical services communications system by the board and which operates

Emergency Medical Responder Course Syllabus Instructor: Assistant Instructor: Instructor Office Hours and Location: One half hour before and after class or by appointment Course Meeting Days and Times:

CHAPTER 6 HEAD INJURY AND UNCONSCIOUSNESS BRAIN INJURY Injury to the brain is one of the more serious outcomes that occur due to injury or illness. The first aider plays a major role in limiting damage

Length of course 1 semester Overview Academy of Health Professions Foundations of Medicine and Health Science This course is designed to introduce students to the variety of health career opportunities

Fainting - Syncope Introduction Fainting, also known as syncope, is a temporary loss of consciousness. It is caused by a drop in blood flow to the brain. You may feel dizzy, lightheaded or nauseous before

Tim Erskine Chief, Trauma Systems and Research Ohio Department of Public Safety » Describe Ohio s legal definition of trauma» List the anatomic and physiologic criteria to be used by when evaluating adult,

American Heart Association Basic Life Support for Healthcare Providers Pretest April 2006 This examination to be used only as a PRECOURSE TEST For BLS for Healthcare Providers Courses 2006 American Heart